On Friday, the Trump administration released its final draft outlining prohibitive regulations for the Title X Family Planning Program, the nation’s only federal grant program dedicated to offering family planning services. The move will prevent organizations like Planned Parenthood from accessing crucial funds, as well as jeopardize access to reproductive health services for four million low-income people across the country.

The Trump administration released the final draft for its domestic gag rule, a policy change first proposed last May, that will ban health care providers from receiving Title X funding if they refer patients to abortion care. “[...] None of the funds appropriated for Title X may be used in programs where abortion is a method of family planning,” the final draft of the rules reads. (To be clear, this final draft will not go into effect until 60 days after it is certified with the Federal Register. The Guttmacher Institute notes that there will likely be legal action).

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The changes to Title X were expected. In an earlier draft of the proposal, the administration wrote that “[T]he proposed rule would prohibit recipients from using Title X funds to perform, promote, refer for, or support abortion as a method of family planning.” In the finalized rule, the administration rewrote Title X, creating a “physical and financial separation” between “Title X program and any activities that fall outside the program’s scope.” The separation outlined in the final draft includes separate accounting records, as well as separate facilities including: “treatment, consultation, examination and waiting rooms, office entrances and exits, shared phone numbers, email addresses, educational services, and websites.” The language in the final draft is reminiscent of the TRAP laws passed by numerous states.

The final draft notes that the now-mandated separation “address[es] concerns over the fungibility of Title X resources and the potential use of Title X.” Title X does not fund abortions, but anti-abortion conservatives have long argued that Title X funds are used to promote abortion. The new rule insists that it prevents Title X resources from “facilitat[ing] the development of, and ongoing use of, infrastructure for non-Title X activities.”

In addition, the final draft “eliminates” the 2000 rule requiring Title X providers to offer abortion counseling, replacing it with what it terms “nondirective counseling.” “Although the 2000 regulations require Title X programs to refer for abortion when requested by a client, the Department no longer believes that the requirement is appropriate or permissible,” the draft notes. The document adds that abortion counseling itself is a violation of Title X (emphasis ours):

The Department believes both the referral for abortion as a method of family planning, and such abortion procedure itself, are so linked that such a referral makes the Title X project or clinic a program one where abortion is a method of family planning, contrary to the prohibition against the use of Title X funds in such programs.

[...]

Accordingly, this final rule removes the requirement that Title X funded entities refer for abortion, and prohibits Title X projects from referring for abortion as a method of family planning, or from performing, promoting, referring for, or supporting abortion as a method of family planning.

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“Fundamentally, on the gag rule, it makes it illegal for providers who are in the program to give a referral for abortion,” Emily Stewart, the Vice President of Public Policy at Planned Parenthood Federation of America, told Jezebel over the phone. “What that means is that they cannot serve people under this program. They cannot provide the affordable cancer screenings, the affordable birth control that’s available under the program, and give people full information about their reproductive health care options as the rule says on the gag side.”

The Guttmacher Institute describes the domestic gag rule as an “ all-out assault” on the Title X program’s ability to offer family planning and reproductive services. “Any attempt to curtail people’s access to trusted providers, gag physicians, push abstinence-only messages, or steer people toward one specific method at the expense of full contraceptive choice is blatantly coercive and a violation of medical ethics and patients’ rights,” the Guttmacher Institute said in a statement to Jezebel.

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The Title X program has been effective in decreasing unwanted pregnancies; according to a 2017 analysis by Guttmacher, in 2015, unintended pregnancy and abortion would have been 31 percent higher, and the teen unintended pregnancy rate would have been 44 percent higher without contraceptives funded by the grants program. Yet Republicans in Congress, in an effort to target abortion and defund Planned Parenthood, have sought to eliminate the program since 2011.

Though a version of the gag rule proposal has existed since 1988, it was never fully implemented until now. The rule is similar to the global gag rule, first introduced by Ronald Reagan and reinstated by the Trump administration last year, which bars foreign organizations from receiving U.S. aid if they, in any way, offer information or support about abortion. The administration opposes abortion and promotes abstinence-only programs for teens.

Stewart says that, as a result of the gag rule, Planned Parenthood will no longer participate in Title X. “We will not ever violate our commitment to ethical patient care and we won’t participate in an unethical Title X program,” she said. “This would completely undermine the patient-provider relationship and harm the public’s health.”

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Millions of low-income women, disproportionately women of color, will face the brunt of the policy. “Forty-one percent of people in the program are going to be left without care as a result of the rule,” she said. “The vast majority of people in this program have incomes below 150 percent of the federal poverty level. For decades, it has been part of our nation’s healthcare safety net. And so this is one of the most dangerous, if not the most dangerous things this administration has done to attack peoples’ access to affordable healthcare.”

“Dismantling Title X will limit health care options even further and worsen the massive divide that already exists in health care,” Planned Parenthood Federation of America said in a statement issued today.